Upper extremity muscle therapy system

ABSTRACT

Some embodiments of the present invention provide systems and methods for treating diminished muscle function. Some systems include an electrical member that delivers electrical energy to a hand region of a body that comprises a dysfunctional muscle; a joint motion assembly that couples to the body and provides, to a joint adjacent the dysfunctional muscle, a motion made up of a cycle of opposing joint movements; and a control unit that provides an operator of the system with control of a timing of electrical energy delivery and an amount of electrical energy delivered. Some systems time the electrical energy delivery to occur when the moving joint is near an inflection point and deliver electrical energy delivered in amounts effective to result in a depolarization of the dysfunctional muscle, a nerve in proximity of the joint, and/or a muscle of substantially normal function in proximity of the joint.

FIELD OF THE INVENTION

The present invention provides muscle-therapy systems and methods fortreating muscles of diminished capacity. Certain embodiments of systemsand methods of the present invention are useful in promoting a return offunction to muscles having diminished capacity due to spinal chordinjury; a partially or completely severed nerve; neurodegenerativedisease, such as ALS-Lou Gehrig's disease, Huntington's disease,multiple sclerosis, and Alzheimer's disease; stroke; transient ischemicattack; surgery; cancer, e.g., by a tumor compression of a nerve;arthritis; aging; athletic injury; etc.

BACKGROUND OF THE INVENTION

Spinal cord injury, neurodegenerative diseases, and stroke arehigh-incidence causes of nueromotor impairments that result indisability due to diminished muscle capacity and/or function. Othercauses disabilities resulting from diminished muscle capacity includesurgery, cancer, arthritis, and aging associated processes.

In the United States, approximately 10,000 people each year sufferspinal cord injury, and over 230,000 people live with disabilities dueto diminished muscle function resulting from spinal cord injury.Diminished muscle function following a spinal cord injury can result in,for example, paralysis, insufficient muscle activity to achievestepping, inadequate weight-bearing capacity, aberrant gait,uncoordinated movement, and balance deficit. Previously knownrehabilitation methods used to treat such disabilities in individualswith spinal cord injury include stretching, strengthening, gaittraining, and the use of mechanical, electrical, and electromechanicaldevices. Although such methods often provide minor improvements in motorabilities in the first, post-injury year, such improvements typicallyplateau at negligible levels. No previously available rehabilitationmethod is reliably effective to overcome diminished muscle functionresulting from spinal cord injury.

In the United States, neurodegenerative diseases such as amyotrophiclateral sclerosis (ALS), cerebral palsy, multiple sclerosis,Huntington's disease, Alzheimer's, etc. occur at high incidence,approximately in a range of from one to seven cases per 100,000 people.Diminished muscle function is a frequent symptom of suchneurodegenerative diseases, and can result in impaired strength,impaired coordination, impaired mobility, impaired speech, andcontracture. Previously known rehabilitation methods used to treatdeficits in individuals with neurodegenerative disease includestretching, strengthening, gait training, and the use of mechanical,electrical, and electromechanical devices. But no previously availablerehabilitation method is reliably effective to overcome diminishedmuscle function resulting from neurodegenerative disease.

In the United States, approximately 750,000 people each year havestrokes, and over 4 million people live with a stroke induceddisability. Diminished muscle function following stroke can develop as aresult of motor neuron cell damage and/or death following a blood clotinduced ischemic event. Diminished muscle function following stroke canalso develop as a result of “learned nonuse,” a phenomenon observed instroke victims who, shortly after the stroke event, experience failurein attempting to move a body part partially or completely paralyzed,temporarily, by the stroke. The stroke victim learns how to compensatefor this partial or complete paralysis by using body parts unaffected orless affected by the stroke to accomplish daily living activities. Suchcompensatory strategies become habit, and, eventually, the victim doesnot attempt to move the affected body part, even when it isneurologically possible to do so.

Previously known rehabilitation methods used to treat diminished musclefunction in stroke victims include stretching, strengthening, gaittraining, and the use of mechanical, electrical, and electromechanicaldevices. But no previously available rehabilitation technique isreliably effective to restore muscle function lost or partially lost asa result of motor neuron cell lesion and/or death. No previouslyavailable rehabilitation technique is reliably effective to overcomediminished muscle function resulting from learned nonuse.

Neuromuscular stimulation devices have previously been developed andused in methods for rehabilitating people suffering from disabilitiesdue to diminished muscle function. For instance, Radwan (U.S. Pat. No.3,387,147) describes a muscle stimulating pulse generator which providesan electric pulse with a relatively high voltage-to-width ratio and asteep wavefront that stimulates muscle contraction. Wyss et al. (U.S.Pat. No. 4,148,321) discloses a muscular therapy device that makesmuscles rhythmically contract and relax at a low frequency by modulatingthe frequency of an electric current delivered to the muscle. Kofskey etal. (U.S. Pat. No. 4,177,819) teaches an apparatus for stimulating amuscle for 2 to 20 seconds at 2 to 50 second intervals using a modulatedelectric current. The contents of each of U.S. Pat. No. 3,387,147; U.S.Pat. No. 4,148,321; and U.S. Pat. No. 4,177,819 are hereby incorporatedby reference in their entireties.

Passive motion devices have previously been developed and used inmethods for rehabilitating people suffering from disabilities due todiminished muscle function. For instance, Pecheux (U.S. Pat. No.4,323,060) describes a motorized splint that supports and providesmotion, to a knee joint of a human leg having diminished muscle functionand Genovese et al. (U.S. Pat. No. 1,825,852) discloses a similar deviceprogrammable to provide a variety of sequences of passive motion for avariety of durations, such as continuous. Wright and Ober (U.S. Pat. No.4,520,827) describes a continuous passive motion apparatus similar tothe Pecheux and Genovese et al. The contents of each of U.S. Pat. No.4,323,060; U.S. Pat. No. 1,825,852; and U.S. Pat. No. 4,520,827 arehereby incorporated by reference in their entireties.

People suffering from diminished muscle function due to spinal chordinjury, neurodegenerative disease, stroke, surgery, cancer, arthritis,aging, etc. face relative inactivity and deterioration of muscles thatwould otherwise be active. Given that no previously known rehabilitationdevice or method is reliably effective in rehabilitating diminishedmuscle function, there is a need for rehabilitation methods and deviceseffective in restoring diminished muscle function.

SUMMARY OF THE INVENTION

Certain embodiments provide a system, for treating diminished musclefunction, comprising: an electrical member that delivers electricalenergy to a portion of a mammalian body, the body comprising adysfunctional muscle; a joint motion assembly that couples to the bodyand provides a joint motion, in a cycle comprising opposing jointmovements, to a joint of the body to which the dysfunctional muscleordinarily provides motion; and a control unit, in communication withthe member and the assembly, that controls (i) a timing of electricalenergy delivery by the member and (ii) an amount of electrical energydelivered by the member; wherein the timing of electrical energydelivery is controlled to occur while both of the following occursimultaneously: (i) the joint is positioned near an inflection pointbetween the opposing joint movements in the cycle, and (ii) motion isbeing provided to the joint by the joint motion assembly; and whereinthe amount of electrical energy delivered is effective to result in adepolarization of at least one of the dysfunctional muscle and a nervethat innervates the dysfunctional muscle. As used herein, a“dysfunctional muscle” may have a diminished capacity because of diseaseor because of disrupted nerve conduction in an upper motor neuron or alower motor neuron.

As the joint moves in one direction and then reverses direction in thecycle, the point at which it reverses direction is referred to herein asthe “inflection point.” When the joint is positioned near an inflectionpoint between the opposing joint movements in the cycle, the joint isnear its point of reversing motion in the cycle.

In certain embodiments, the depolarization results in a contraction ofthe dysfunctional muscle. In certain embodiments, the contractionresults in a force on the joint that is antagonistic to the jointmovement being provided by the joint motion assembly at the time ofcontraction. In certain embodiments, the contraction results in a forceon the joint that is protagonistic to the joint movement being providedby the joint motion assembly at the time of contraction.

In certain embodiments, the member delivers the electrical energy whenthe joint is within about 20 degrees of the inflection point. In certainembodiments, the member delivers the electrical energy when the joint iswithin about 15 degrees of the inflection point. In certain embodiments,the member delivers the electrical energy when the joint is within about10 degrees of the inflection point. In certain embodiments, the memberdelivers the electrical energy when the joint is within about 5 degreesof the inflection point.

In certain embodiments, the system further comprises a vibratory member,in communication with the control unit, that delivers vibratory energyto the portion of the body effective to result in activation of amechanoreceptor in proximity to the joint.

Certain embodiments of providing a method, for treating diminishedmuscle function, comprising: contacting an electrical member, configuredto deliver electrical energy, to a portion of a mammalian body, the bodycomprising a dysfunctional muscle; with a joint motion assembly,providing a joint motion, in a cycle comprising opposing jointmovements, to a joint of the body to which the dysfunctional muscleordinarily provides motion; and with the electrical member, deliveringan amount of electrical energy to the portion of the body while both ofthe following occur simultaneously: (i) the joint is positioned near aninflection point between the opposing joint movements in the cycle, and(ii) the joint motion is being provided to the joint; wherein the amountof electrical energy delivered is effective to result in adepolarization of at least one of the dysfunctional muscle and a nervethat innervates the dysfunctional muscle.

In certain embodiments, the depolarization results in a contraction ofthe dysfunctional muscle. In certain embodiments, the contractionresults in a force on the joint that is antagonistic to the jointmovement being provided by the joint motion assembly at the time ofcontraction. In certain embodiments, the contraction results in a forceon the joint that is protagonistic to the joint movement being providedby the joint motion assembly at the time of contraction. In certainembodiments, the delivery of electrical energy occurs when the joint iswithin about 20 degrees of the inflection point. In certain embodiments,the delivery of electrical energy occurs when the joint is within about15 degrees of the inflection point. In certain embodiments, the deliveryof electrical energy occurs when the joint is within about 10 degrees ofthe inflection point. In certain embodiments, the delivery of electricalenergy occurs when the joint is within about 5 degrees of the inflectionpoint.

In certain embodiments, the joint comprises an ankle joint, and whereinthe opposing joint movements comprise a dorsiflexion and aplantarflexion of the ankle joint, and wherein the inflection point iswithin about 10 degrees of full plantarflexion.

In certain embodiments, the joint comprises an ankle tarsal joint, andwherein the opposing joint movements comprise an inversion and aneversion of the tarsal joint, and wherein the inflection point is withinabout 10 degrees of full inversion or eversion.

In certain embodiments, the joint comprises a subtalar joint of theankle, and the opposing joint movements comprise an inversion and aneversion of the subtalar joint, and wherein the inflection point iswithin about 10 degrees of full inversion or eversion.

In certain embodiments, the joint comprises a knee joint, and whereinthe opposing joint movements comprise a flexion and an extension of theknee joint, and wherein the inflection point is within about 10 degreesof full extension.

In certain embodiments, the joint comprises a hip joint, and wherein theopposing joint movements comprise a flexion and an extension of the hipjoint, and wherein the inflection point is within about 10 degrees offull flexion or extension.

In certain embodiments, the joint comprises a hip joint, and wherein theopposing joint movements comprise an abduction and an adduction of thehip joint, and wherein the inflection point is within about 10 degreesof full abduction or adduction.

In certain embodiments, the joint comprises a hip joint, and wherein theopposing joint movements comprise an medial rotation and a lateralrotation of the hip joint, and wherein the inflection point is withinabout 10 degrees of full medial rotation or lateral rotation.

In certain embodiments, the joint comprises a shoulder joint, andwherein the opposing joint movements comprise a flexion and an extensionof the shoulder joint, and wherein the inflection point is within about10 degrees of full flexion or extension.

In certain embodiments, the joint comprises a shoulder joint, andwherein the opposing joint movements comprise a medial rotation and alateral rotation of the shoulder joint, and wherein the inflection pointis within about 10 degrees of full medial rotation or lateral rotation.

In certain embodiments, the joint comprises an elbow joint, and whereinthe opposing joint movements comprise a flexion and an extension of theelbow joint, and wherein the inflection point is within about 10 degreesof full flexion or extension.

In certain embodiments, the joint comprises an elbow joint, and whereinthe opposing joint movements comprise a pronation and a supination ofthe elbow joint, and wherein the inflection point is within about 10degrees of full pronation or supination.

In certain embodiments, the joint comprises a wrist joint, and whereinthe opposing joint movements comprise a flexion and an extension of thewrist joint, and wherein the inflection point is within about 10 degreesof full flexion or extension.

In certain embodiments, the joint comprises a wrist joint, and whereinthe opposing joint movements comprise a supination and a pronation ofthe wrist joint, and wherein the inflection point is within about 10degrees of full pronation or supination.

In certain embodiments, the joint comprises a wrist joint, and whereinthe opposing joint movements comprise an ulnar deviation and a radialdeviation of the wrist joint, and wherein the inflection point is withinabout 10 degrees of full ulnar deviation or radial deviation.

In certain embodiments, the vibratory member delivers the vibratoryenergy when the joint is within about 20 degrees of the inflectionpoint. In certain embodiments, the vibratory member delivers thevibratory energy when the joint is within 15 degrees of the inflectionpoint.

In certain embodiments, the vibratory member delivers the vibratoryenergy when the joint is within 10 degrees of the inflection point. Incertain embodiments, the vibratory member delivers the vibratory energywhen the joint is within 5 degrees of the inflection point.

In certain embodiments, a vibratory member, delivers vibratory energy tothe portion of the body. In certain embodiments, the vibratory memberdelivers the vibratory energy when the joint is within about 20 degreesof the inflection point. In certain embodiments, the vibratory memberdelivers the vibratory energy when the joint is within about 15 degreesof the inflection point. In certain embodiments, the vibratory memberdelivers the vibratory energy when the joint is within about 10 degreesof the inflection point. In certain embodiments, the vibratory memberdelivers the vibratory energy when the joint is within about 5 degreesof the inflection point.

Certain embodiments provide a hand apparatus, for treating diminishedmuscle function, comprising: an electrical member that deliverselectrical energy to a hand region comprising at least one of a digit, ahand, and a wrist, the hand region comprising a dysfunctional muscle; ahand joint motion assembly that couples to the hand region and providesa joint motion, in a cycle comprising opposing joint movements, to ajoint of the hand, and the hand region to which the dysfunctional muscleordinarily provides motion; and a control unit, in communication withthe member and the assembly, that provides an operator of the systemwith control of: (i) a timing of electrical energy delivery by themember, and (ii) an amount of electrical energy delivered by the member;wherein the timing of electrical energy delivery is controlled to occurwhile both of the following occur simultaneously: (i) the joint is nearan inflection point between opposing joint movements in the cycle, and(ii) motion is being provided to the joint by the joint motion assembly;and wherein the amount of electrical energy delivered is effective toresult in a depolarization of at least one of the dysfunctional muscleand a nerve that innervates the dysfunctional muscle. As used herein, a“dysfunctional muscle” may have a diminished capacity because of diseaseor because of disrupted nerve conduction in an upper motor neuron or alower motor neuron.

In certain embodiments, the depolarization results in a contraction ofthe dysfunctional muscle. In certain embodiments, the contractionresults in a force on the joint that is antagonistic toward the jointmovement being provided by the joint motion assembly at the time ofcontraction. In certain embodiments, the contraction results in a forceon the joint that is protagonistic toward the joint motion beingprovided by the joint motion assembly at the time of contraction.

In certain embodiments, the member delivers the electrical energy whenthe joint is within about 20 degrees of the inflection point. In certainembodiments, the member delivers the electrical energy when the joint iswithin about 15 degrees of the inflection point. In certain embodiments,the member delivers the electrical energy when the joint is within about10 degrees of the inflection point. In certain embodiments, the memberdelivers the electrical energy when the joint is within about 5 degreesof the inflection point.

In certain embodiments, a system comprises a vibratory member, incommunication with the control unit, that delivers vibratory energy toat least one of the digit, the hand, and the wrist effective to resultin activation of a mechanoreceptor in proximity to the joint. In certainembodiments, the vibratory member delivers the vibratory energy when thejoint is within about 20 degrees of the inflection point. In certainembodiments, the vibratory member delivers the vibratory energy when thejoint is within 15 degrees of the inflection point. In certainembodiments, the vibratory member delivers the vibratory energy when thejoint is within 10 degrees of the inflection point. In certainembodiments, the vibratory member delivers the vibratory energy when thejoint is within 5 degrees of the inflection point.

In certain embodiments, the joint comprises a wrist joint, and whereinthe opposing joint movements comprise a flexion and an extension of thewrist joint, and wherein an inflection point joint angle for the flexionmovement is in a range of from about 45 degrees to about 95 degrees, andwherein an inflection point joint angle for the extension movement is ina range of from about 45 degrees to about 95 degrees.

In certain embodiments, the joint comprises a wrist joint, and whereinthe opposing joint movements comprise a supination and a pronation ofthe wrist joint, and wherein an inflection point joint angle for thesupination movement is in a range of from about 45 degrees to about 90degrees, and wherein an inflection point joint angle for the pronationmovement is in a range of from about 45 degrees to about 90 degrees.

In certain embodiments, the joint comprises a wrist joint, and whereinthe opposing joint movements comprise an ulnar deviation and a radialdeviation of the wrist joint, and wherein an inflection point jointangle for the ulnar deviation movement is in a range of from about 20degrees to about 40 degrees, and wherein an inflection point joint anglefor the radial deviation movement is in a range of from about 10 degreesto about 25 degrees.

In certain embodiments, the joint comprises a finger metacarpophalangealjoint, and wherein the opposing joint movements comprise a flexion andan extension of the metacarpophalangeal joint, and wherein an inflectionpoint joint angle for the flexion movement is in a range of from about45 degrees to about 90 degrees, and wherein an inflection point jointangle for the extension movement is in a range of from about 0 degreesto about negative 10 degrees.

In certain embodiments, the joint comprises a proximal interphalangealjoint of a finger, and wherein the opposing joint movements comprise aflexion and an extension of the proximal interphalangeal joint, andwherein an inflection point for the flexion movement is in a range offrom about 60 degrees to about 120 degrees, and wherein an inflectionpoint joint angle for the extension movement is in a range of from about5 degrees to about negative 10 degrees.

In certain embodiments, the joint comprises a distal interphalangealjoint of a finger, and wherein the opposing joint movements comprise aflexion and an extension of the distal interphalangeal joint, andwherein an inflection point for the flexion movement is in a range offrom about 45 degrees to about 90 degrees, and wherein an inflectionpoint joint angle for the extension movement is in a range of from about5 degrees to about negative 10 degrees.

In certain embodiments, the joint comprises a metacarpophalangeal jointof a thumb, and wherein the opposing joint movements comprise a flexionand an extension of the metacarpophalangeal joint, and wherein aninflection point for the flexion movement is in a range of from about 35degrees to about 70 degrees, and wherein an inflection point joint anglefor the extension movement is in a range of from about 5 degrees toabout negative 10 degrees.

In certain embodiments, the joint comprises an interphalangeal joint ofa thumb, and wherein the opposing joint movements comprise a flexion andan extension of the interphalangeal joint, and wherein an inflectionpoint for the flexion movement is in a range of from about 30 degrees toabout 60 degrees, and wherein an inflection point joint angle for theextension movement is in a range of from about 5 degrees to aboutnegative 10 degrees.

Certain embodiments provide a method, for treating diminished musclefunction, comprising: contacting an electrical member, configured todeliver electrical energy, to a hand region comprising at least one of adigit, a hand, and a wrist, the hand region comprising a dysfunctionalmuscle; with a joint motion assembly, providing a joint motion, in acycle comprising opposing joint movements, to a joint of the hand regionto which the dysfunctional muscle ordinarily provides movement; and withthe electrical member, delivering an amount of electrical energy to thehand region while both of the following occur simultaneously: (i) thejoint is positioned near an inflection point of opposing jointmovements, and (ii) the joint motion is being provided to the joint;wherein the amount of electrical energy delivered is effective to resultin a depolarization, in the hand region, of at least one of thedysfunctional muscle and a nerve that innervates the dysfunctionalmuscle.

In certain embodiments, the depolarization results in a contraction thedysfunctional muscle. In certain embodiments, the contraction results ina force on the joint that is antagonistic toward the joint movementbeing provided by the joint motion assembly at the time of contraction.In certain embodiments, the contraction results in a force on the jointthat is protagonistic toward the joint movement being provided by thejoint motion assembly at the time of contraction.

In certain embodiments, the delivery of electrical energy occurs whenthe joint is within about 20 degrees of the inflection point. In certainembodiments, the delivery of electrical energy occurs when the joint iswithin 15 degrees of the inflection point. In certain embodiments, thedelivery of electrical energy occurs when the joint is within 10 degreesof the inflection point. In certain embodiments, the delivery ofelectrical energy occurs when the joint is within 5 degrees of theinflection point.

In certain embodiments, a method comprises contacting at least one ofthe finger, the thumb, and the hand with a vibratory member, thevibratory member in communication with the control unit and configuredto deliver vibratory energy to the least one of the finger, the thumb,and the hand; and with a control unit in communication with thevibratory member and the assembly, controlling, during the contacting ofthe vibratory member and the least one of the finger, the thumb, and thehand, vibratory energy delivery to occur: (i) when the joint is near aninflection point of opposing joint movements and while motion isprovided to the joint by the joint motion assembly, and (ii) in anamount effective to result in a depolarization, in the hand region, of aGolgi body that is in proximity of the joint.

In certain embodiments, the vibratory member delivers the vibratoryenergy when the joint is within about 20 degrees of the inflectionpoint. In certain embodiments, the vibratory member delivers thevibratory energy when the joint is within about 15 degrees of theinflection point. In certain embodiments, the vibratory member deliversthe vibratory energy when the joint is within about 10 degrees of theinflection point. In certain embodiments, the vibratory member deliversthe vibratory energy when the joint is within about 5 degrees of theinflection point.

In certain embodiments, the joint comprises a wrist joint, and whereinthe opposing joint movements comprise a flexion and an extension of thewrist joint, and wherein an inflection point joint angle for the flexionmovement is in a range of from about 45 degrees to about 95 degrees, andwherein an inflection point joint angle for the extension movement is ina range of from about 45 degrees to about 95 degrees.

In certain embodiments, the joint comprises a wrist joint, and whereinthe opposing joint movements comprise a supination and a pronation ofthe wrist joint, and wherein an inflection point joint angle for thesupination movement is in a range of from about 45 degrees to about 90degrees, and wherein an inflection point joint angle for the pronationmovement is in a range of from about 45 degrees to about 90 degrees.

In certain embodiments, the joint comprises a wrist joint, and whereinthe opposing joint movements comprise an ulnar deviation and a radialdeviation of the wrist joint, and wherein an inflection point jointangle for the ulnar deviation movement is in a range of from about 20degrees to about 40 degrees, and wherein an inflection point joint anglefor the radial deviation movement is in a range of from about 10 degreesto about 25 degrees.

In certain embodiments, the joint comprises a finger metacarpophalangealjoint, and wherein the opposing joint movements comprise a flexion andan extension of the metacarpophalangeal joint, and wherein an inflectionpoint joint angle for the flexion movement is in a range of from about45 degrees to about 90 degrees, and wherein an inflection point jointangle for the extension movement is in a range of from about 0 degreesto about negative 10 degrees.

In certain embodiments, the joint comprises a proximal interphalangealjoint of a finger, and wherein the opposing joint movements comprise aflexion and an extension of the proximal interphalangeal joint, andwherein an inflection point for the flexion movement is in a range offrom about 60 degrees to about 120 degrees, and wherein an inflectionpoint joint angle for the extension movement is in a range of from about5 degrees to about negative 10 degrees.

In certain embodiments, the joint comprises a distal interphalangealjoint of a finger, and wherein the opposing joint movements comprise aflexion and an extension of the distal interphalangeal joint, andwherein an inflection point for the flexion movement is in a range offrom about 45 degrees to about 90 degrees, and wherein an inflectionpoint joint angle for the extension movement is in a range of from about5 degrees to about negative 10 degrees.

In certain embodiments, the joint comprises a metacarpophalangeal jointof a thumb, and wherein the opposing joint movements comprise a flexionand an extension of the metacarpophalangeal joint, and wherein aninflection point for the flexion movement is in a range of from about 35degrees to about 70 degrees, and wherein an inflection point joint anglefor the extension movement is in a range of from about 5 degrees toabout negative 10 degrees.

In certain embodiments, the joint comprises an interphalangeal joint ofa thumb, and wherein the opposing joint movements comprise a flexion andan extension of the interphalangeal joint, and wherein an inflectionpoint for the flexion movement is in a range of from about 30 degrees toabout 60 degrees, and wherein an inflection point joint angle for theextension movement is in a range of from about 5 degrees to aboutnegative 10 degrees.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1 illustrates an embodiment of a joint motion assembly configuredto provide motion to an ankle joint of a user of the system.

FIGS. 2A and 2B illustrate embodiments of a joint motion assemblyconfigured to provide motion to a knee joint of a user of the system.

FIGS. 3A and 3B illustrate embodiments of a joint motion assemblyconfigured to provide motion to a hip joint of a user of the system.

FIG. 4 illustrates an embodiment of a joint motion assembly configuredto provide motion to a shoulder joint of a user of the system.

FIGS. 5A and 5B illustrate embodiments of a joint motion assemblyconfigured to provide motion to an elbow joint of a user of the system.

FIG. 6 illustrates an embodiment of a joint motion assembly configuredto provide motion to a wrist joint of a user of the system.

FIGS. 7A and 7B illustrate embodiments of a joint motion assembly, andparts thereof, configured to provide motion to joints of a thumb, afinger, a wrist, a hand, or a combination thereof, of a user of thesystem.

FIG. 8 illustrates an embodiment of a control box of the presentinvention.

FIG. 9 illustrates a diagram of communications between components of anembodiment of a muscle therapy system.

DETAILED DESCRIPTION IF THE INVENTION

Certain embodiments of the present invention provide a muscle-therapysystem, for treating a muscle of diminished function of a user of thesystem, comprising an electrical lead that delivers electrical energy toa region of a body of the user of the system in a proximity of a muscleof diminished function of the user; a passive joint motion assembly thatcouples to the body of the user of the system and thereby provides, to ajoint of the body adjacent the muscle of diminished function, a jointmotion that comprises a series of opposing joint movements; and acontrol unit that is in communication with the lead and the passivejoint motion assembly so as to provide an operator of the system withcontrol of a timing of electrical energy delivery by the lead, relativeto the series of opposing joint movements, and an amount of electricalenergy delivered by the lead.

In some embodiments, the system comprises a start switch, and thecontrol unit is configured to start operation of the passive jointmotion assembly in response to an input signal received from the startswitch. In some embodiments, the system comprises a stop switch, and thecontrol unit is configured to stop operation of the passive joint motionassembly in response to an input signal received from the stop switch,and the operator of the system can switch the start and stop switches.In some embodiments, the operator of the system can be a microprocessor,a healthcare provider, the user of the system, or a combination thereof.

In some embodiments, joint angles between inflection points of opposingjoint movements provided by the joint motion assembly define a jointmotion within a physiologic range.

In some embodiments, delivery of electrical energy by the lead iscontrolled to occur near, and not at, one or more inflection point(s) ofjoint movement, while the joint motion assembly provides motion to thejoint; and the amount of electrical energy delivered by the lead iscontrolled to result in a depolarization of the muscle of diminishedfunction, a nerve that is in a proximity of the joint, and/or a muscleof physiologic function that is in a proximity of the joint.

In certain embodiments, the system comprises a drive unit, coupled tothe joint motion assembly, that provides movement to the joint motionassembly; and the drive unit can be in communication with the controlunit. In some embodiments, the system comprises a joint motion assemblyposition sensor, in communication with the control unit, that providessignals indicative of the position of the joint motion assembly. In someembodiments, the control unit, in response to signals from the jointmotion assembly position sensor, causes the drive unit to change adirection of the movement it provides to the joint motion assembly. Insome embodiments, the control unit, in response to signals received fromthe joint motion assembly position sensor, causes the delivery ofelectrical energy by the lead.

In certain embodiments, the joint motion assembly is adapted to providemotion to an ankle joint of the user. Ankle joint motion assemblies areknown in the art, and include assemblies such as the one illustrated inFIG. 1 1, which comprises a single piece or two piece carriage member 5having sole region 10 and ankle region 15. In certain single pieceembodiments, carriage member 5 comprises a flexible material, such as aplastic, and a cutout at heel region 20 to provide flexibility tocarriage 5. In some embodiments, a transverse bend line is located alonga transverse axis 25 through cutout 30. In certain two pieceembodiments, an ankle joint motion assembly can comprise a hinge (notshown) that flexibly couples upper and lower regions of carriage 5 abouttransverse bend line 25. Ankle joint motion assembly 1 comprises padding35 positioned between a foot, leg and ankle of the user, 40, 15, 45,respectively, and carriage member 5. Ankle joint motion assembly 1comprises a detachable strap 50 for coupling the assembly 1 onto a foot40 of the user. Ankle joint motion assembly 1 comprise adjustable rightand left side straps 55 and 60, respectively, coupled to an upper end ofankle region 15 by a back-strap 65 and extend under sole region 10 forenabling alignment of foot 40. Joint motion assembly 1 comprises driveunit coupling members that couple upper and lower regions of carriage 5to a drive unit that provides motion to assembly 1 and, thereby,movement to an ankle joint of the user of the system.

In certain embodiments, a joint motion assembly is adapted to providemotion to a knee joint of the user. Exemplary knee joint motionassemblies are known in the art, and include assemblies such as the oneillustrated in FIG. 2 201, which comprises a pair of parallel rearwardsupport links 205, a pair of parallel forward support links 210, a pairof drag links 215, a pair of femur support members 220, a pair of tibiasupport members 225, thigh support saddle 230, calf support saddle 235,foot support 240, connector 245, and connecting link 250. Links 205,215, 220 and support members 220, 225 form a linkage that transmitsdrive power provided by drive unit 255 through crank 260 and link 265 toprovide opposing knee joint 270 movements of extension (an exemplaryinflection point joint angle of the extension is shown in FIG. 2A) andflexion (an exemplary inflection point joint angle of the flexionmovement is shown in FIG. 2B).

In some embodiments, a joint motion assembly position sensor comprises apotentiometer that communicates, to the control unit, signals ofincreasing voltage proportional to increasing angles of components ofthe joint motion assembly. For example, joint motion assembly positionsensor potentiometer 260, illustrated in FIGS. 2A and 2B, is connectedto arm 290 links 280 and 285. The signal from potentiometer 275 can bean analog voltage signal, which can be converted to a digital signal,that is proportional to the angular position of arm 290. Forward supportlinks 210 are pivotally connected to frame 299 by pivot shaft 295. Arm290 is fixedly connected to pivot shaft 295, so that the angularposition of arm 290 follows the angular position of forward supportlinks 210. As a result, the joint motion assembly position signalprovided by potentiometer 275 has a magnitude representative of theposition of knee joint motion assembly 201 in its operating cycle ofproviding knee joint flexion and extension movements.

In certain embodiments, the joint motion assembly is adapted to providemotion to a hip joint of the user. Hip joint motion assemblies are knownin the art, and include assemblies such as the one illustrated in FIG. 3301, which comprises a single piece or two piece plate 305 and adetachable and adjustable leg attachment element 310. Plate 305 can beformed from flexible material, such as plastic, and configured to bothsupport a hip region of the user and for bending about a transverse bendline 315. In certain two piece embodiments, plate 305 can be formed froman inflexible material, and comprise a hinge (not shown) that flexiblycouples upper and lower regions, 320 and 325, respectively, of plate 305about transverse bend line 315. In some embodiments, plate 305 comprisesa slit that aligns with a thigh region of the user along a longitudinalaxis 330, the slit defining side-by-side first and second thigh regions335 and 340, respectively. Leg attachment element 310 is installedthrough slots 360 in either first or second thigh regions 335 or 340. Insome embodiments, a hip joint motion assembly can comprise two legattachment elements. Hip joint motion assembly 301 comprises a paddedsleeve 325 (FIG. 3) installed over plate 305 to provide comfort to theuser. When the user is lying on a surface 345, such as a massage tableand plate 305, leg attachment element 310 is installed around a thighregion 350 of the user and tightened to couple thigh 350 against region335 of assembly 301, upper plate region 320 being held down by theuser's weight. Assembly 301 can comprise drive unit coupling members(not shown) that couple upper plate region and lower plate regions, 325and 320, respectively, to a drive unit (not shown) that provides motionto a joint motion assembly and, thereby, movement to a hip joint of theuser of the system.

In certain embodiments, a joint motion assembly is adapted to providemotion to a shoulder joint of the user. Shoulder joint motion assembliesare known in the art, and include assemblies such as the one illustratedin FIG. 4 401, which comprises a flexible support element 405 having aninternal recess or pocket 415 for receiving one or more flexibleelements sized and configured (e.g., of increasingly denser or stiffermaterials) to provide desired shoulder joint angles formed by thepositioning of arm 420 relative to shoulder 425. Shoulder joint motionassembly 401 comprises a pad 430 that is positionable between supportelement 405 and arm 420 and thorax 435 of user 455 to provide comfort touser 455. Arm attachment elements 440, 445, 450 are configured to coupleassembly 401 to arm 420 of user 455. In some embodiments, shoulder jointmotion assembly 401 comprises drive unit coupling members (not shown)that couple the shoulder joint motion assembly to a drive unit thatprovides motion to the assembly and, thereby, movement to a shoulderjoint of the user of the system.

In certain embodiments, the joint motion assembly is adapted to providemotion to an elbow joint of the user. Elbow joint motion assemblies areknown in the art, and include assemblies such as the one illustrated inFIGS. 5A and 5B 501, which comprises an upper arm or humerus support522, an elbow or flexion assembly 524, and a wrist orpronation/supination assembly 526. Upper arm or humerus support 522comprises a lower or distal humerus cuff 528 and an upper or proximalhumerus cuff 530. Cuff 530 is slidably mounted along cuff support 532.

Lower cuff strap 534 (FIG. 5B) is coupled to lower humerus cuff 528(FIG. 5A), and an upper cuff humerus strap 536 (FIG. 5B) is coupled tothe proximal humerus cuff 530 (FIG. 5A). Straps 534 and 536 (FIG. 5A)can comprise fasteners, such as hook and loop fasteners, to allow forattachment and adjustment. A distance between the lower humerus cuff 528and the proximal humerus cuff 530 can be adjusted to ensure that device501 is securely attached to the patient shown in phantom 538.

Elbow assembly 524 comprises first and second elbow actuators 540 and542, respectively, spaced apart top and bottom orthosis rods 544 and 546and barrel nut assembly 548. First 540 and second 542 elbow actuatorscan be slidably coupled on side portions and top and bottom orthosisrods 544 and 546, respectively.

One of first 540 and second 542 elbow actuators can comprise a driveflexion elbow actuator and the other can comprise an idler elbowactuator. Elbow actuators 540 and 542 can each have a co-linear elbowaxis of rotation 556. Barrel nut assembly 548 couples with threaded typeconnections at one end to first elbow actuator 540 and at the other endto second elbow actuator 542. Rotation of nut 558 in one directioncauses elbow actuators 540 and 542 to move toward each other androtation in the other direction causes them to move away from eachother. As elbow actuators 540 and 542 move relative to each other theelbow axis of rotation 556 remains co-linear.

The elbow assembly 524 can be configured to be adjustable in order toaccommodate patients with different sized elbows and different positionof the elbow axis or rotation relative to humerus support 522. First andsecond elbow actuators 540 and 542 can slidably move along top andbottom orthosis rods 544 and 546, away from each back portion, resultingin a decrease of a distance of elbow axis 556 relative to humerussupport 522 and accompanied by a proportionately increased distancebetween the first and second elbow actuators 540 and 542. So, byadjusting the barrel nut assembly 548, the patient or health care workeruses one adjustment to accommodate differences in upper armcircumferences and differences in position of the arm elbow anatomicaxis relative to the posterior surface of the arm.

First and second actuators 540 and 542 comprise first and secondrotating shafts 560 and 562, respectively. Rotating shafts 560 and 562can rotate in a concentric fashion with elbow axis 556. First and seconddrive stays 564 and 566, respectively, are connected at one end to firstand second rotating shafts 560 and 562. At the other end, first andsecond drive stays 564 and 566 can be are connected to valgus pivot 568.Pronation-supination assembly 526 can be coupled to valgus pivot 568.

Pronation-supination assembly 526 includes pronation-supination housing570, housing shaft 572, ring assembly 574, and ulna clamping device 576.Housing shaft 572 can comprise a pair of parallel rods 573.Pronation-supination housing 570 can be slidably coupled to parallelrods 573 so as to be movable along the rods. Rods 573 can comprise abent portion at the distal end, which limits movement of thepronation-supination housing 570. At the other end rods 573 can becoupled to valgus pivot 568.

Ring assembly 574 comprises a variable ulna clamp 576 on the insidethereof. Padding and soft materials 580 can be coupled to screw clampsfor comfort. Screw clamps 576 can be adjustable to compensate forvariations in the size of a patient's distal radius and ulna as well ascentering the patient's limb along pronation-supination axis 582. Thecenter of ring assembly 574 can be concentric with pronation-supinationaxis 582. The soft materials 580 of pronation-supination assembly 526can be secured to the ulna clamping mechanism 576, and soft materials580 provide a comfortable patient interface and drive point for thedistal radius and ulna. Soft materials 580 can accommodate a range ofwrist flexion and deviation positions when secured to thepronation-supination drive.

Ring assembly 574 can be slidably mounted in pronation-supinationhousing 570. An external belt 584 can move the ring in a rotationalfashion relative to pronation-supination housing 570.Pronation-supination housing 570 can include a pronation-supinationactuator that drives belt 584, which in turn drives ring assembly 574.Ring assembly 574 is sized to allow the distal portion of the forearm ofthe patient to be positioned and secured in the center of the ringassembly 574. Pronation-supination axis 582 can be arranged such that itis concentric with the anatomic axis of the patient's forearm.Pronation-supination housing 570 can be slidably mounted in a radialfashion relative to the elbow axis. Ulna clamp device 576 can beconfigured to secure the patient's distal radius and ulna so as toeffectively transfer flexion and pronation-supination from the humerusto the forearm. Ulna clamp device 576 can be secured at the patient'sdistal radius and ulna wrist bone, or at any position along the ulna.

In certain embodiments, the joint motion assembly is adapted to providemotion to a wrist joint of the user. Exemplary passive wrist jointmotion assemblies are known in the art, and include the assemblyillustrated in FIG. 6 601, which comprises main housing unit 622, havingupper portion 624 and lower portion 626, which can be configured to forman enclosure that can house a motion producing device and other internalcomponents of the continuous passive motion assembly. Yoke member 628comprises two spaced-apart arms 630, and can be rigidly supported by andextends outwardly from upper portion 624 of main housing unit 622. Yokemember 628 can be integrally formed with upper portion 624 of mainhousing unit 622. Yoke member 628 can also constitute a separatearticle, which can be formed of a different material and coupled to mainhousing unit 622. A plurality of stiffening ribs 632 can be provided oneach of arms 630 in the area between each of arms 630 and upper portion624 of main housing unit 622 to provide enhanced structural support andstrength to arms 630.

At outward (i.e., remote from main housing unit 622) ends ofspaced-apart arms 630, coaxially arranged first pivotal connection parts634 (which together comprise a first pivotal connection) can beconfigured to pivotally connect outer ends of each of spaced-apart arms630 to first link mechanism 636. As shown in FIG. 6, first pivotalconnection parts 634 can be configured as ball joints that accommodaterelative angular movement between yoke 628 and first link mechanism 636about axes perpendicular to pivot axis of first pivotal connection parts634.

First link mechanism 636 can be generally V-shaped when viewed from theside or longitudinal cross-section. First link mechanism 636 cancomprise first bifurcated leg portion 638 and second bifurcated legportion 640, coupled to one another so as to form an acute angletherebetween in the vicinity of an apex or apex portion. Accordingly,the first link mechanism can be a rigid, unitarytorque/force-transmitting member. The term “link mechanism” as usedherein encompasses both a unitary torque/force-transmitting member madefrom a single piece and a torque/force-transmitting arrangement madefrom a plurality of pieces which function in unison.

As shown in FIG. 6, bifurcated leg portion 638 terminates in a pair offree ends 644 at a position remote from an apex portion. Free ends 644together constitute an end portion of first bifurcated leg portion 638,and can be connected to an end of yoke member 628 (constituted by theouter ends of the spaced-apart arms 630) remote from main housing unit622 at first pivotal connection. Hand supporting assembly 646 is mountedon first link mechanism 636 at a position near apex portion 642.

Main housing unit 622, yoke member 628, first pivotal connection parts634, and hand-supporting assembly 646 can be arranged so that, when mainhousing unit 622 is secured to a forearm of a user, a carpal joint ofthe user's wrist is in general alignment with first pivotal connectionand the user's hand is substantially horizontally supported byhand-supporting assembly 646. In securing a forearm of the user to mainhousing unit 622, upper portion 624 can be configured with a pluralityof longitudinally arranged securing elements 648 (which may take theform of removable rods). The forearm of the user is secured to a forearmsplint 648 a which includes two sets of two parallel channels 648 b eachfor slidably receiving a securing element 648. Straps or attachingportions of soft materials (not shown) is adaptable so as to be fedbeneath securing elements 648 and wrapped around the user's forearm,thereby securing the user's forearm to top portion 624 of main housingunit 622 without the need for splint 648 a. The user's hand can rest onhand-supporting assembly 646. In certain embodiments, a strap (notshown) can be used to secure the user's hand to the hand-supportingassembly.

Other passive joint motion assemblies are known in the art and can beused in practicing certain embodiments of the present invention, such asthose described in U.S. Pat. Nos. 5,458,560, 6,456,884, and 7,101,347,the entire contents of which are hereby incorporated by reference intheir entireties.

In certain embodiments, the passive joint motion assembly is adapted toprovide motion to a hand of the user. As used herein, a “hand jointmotion” assembly refers to a joint motion assembly adapted to providemotion to at least one of a finger joint, a thumb joint, and a wristjoint of the user. Exemplary hand joint motion assemblies of the presentinvention include assembly 701 illustrated in FIG. 7. Hand joint motionassembly 701 comprises forearm support member 705 and finger/thumb pivotassemblies 715. Forearm support member 705 and finger/thumb pivotassemblies 715 can comprise an inflexible material, such as metal,plastic, carbon fiber, wood, or combinations thereof. In certainembodiments, forearm support member 705 and finger/thumb pivotassemblies 715 can comprise structures that, together, confer aglove-like shape to the hand joint motion assembly 701.

Hand joint motion assembly 701 comprises user coupling elements 720, anduser coupling elements 720 can be secured to the frame by securingmembers, such as slots 725. Other suitable securing members includeVelcro, buttons, and hook and loop type securing members (not shown).User coupling elements 720 are configured to adjustably and reversiblycouple a forearm region of the user's body to hand joint motion assembly701. User coupling elements 720 can comprise fasteners, such as Velcro,buttons, and a hook and loop fasteners.

Forearm support member 705, finger/thumb pivot assembly 715, or acombination thereof, can be configured to adjustably conform to aphysiologic curve of a forearm, a wrist, a hand, a thumb, a finger, or acombination thereof, of a normal human. Forearm support member 705,thumb/finger pivot assembly 715, or a combination thereof, can also beconfigured to adjustably conform to a non-physiologic curve of aforearm, wrist, hand, thumb, finger, or combination thereof, of theuser.

FIG. 7B illustrates a finger/thumb pivot assembly 715, of hand jointmotion assembly 701, comprises rear finger pivot 717, center fingerpivot member 719, and drive member coupling element 721. Rear fingerpivot member 717 couples to rear finger housing member 723, which isconfigured to reversibly couple to a distal portion of a finger of auser of the system such as a distal interphalangeal segment and a middlephalanx segment. Rear finger housing member 723 comprises rear fingersupport frame 725, which is configured to reversibly receive and supportthe distal portion of the user's finger while providing motion to ajoint in proximity to the distal portion of the user's finger, such asan interphalangeal joint, including distal and proximal interphalangealjoints. Rear finger support frame 725 can comprise an inflexiblematerial, such as metal, wood, plastic, and carbon fiber. Rear fingersupport frame 725 comprises rear finger coupling element 727, which canbe, e.g., a strap, a string, or a belt that reversibly couples thedistal portion of the finger to rear finger housing member 723 and,thereby, to finger pivot assembly 715. Rear finger coupling element 727can comprise a fastener, such as Velcro, buttons, and hook and loop typefastener members.

Rear finger housing member 723 comprises rear finger securing element731, which comprises tap 733. Finger pivot 717 also comprises tap 733.Tap 733 is configured to adjustably receive a pin or a bolt typefastener (not shown), which provides a pivotally adjustable andreversibly fixed connection between rear finger housing member 723 andrear finger pivot member 717.

Finger pivot assembly 715 also comprises rear finger arm 735, which isconfigured to provide a slidably adjustable and reversibly fixedconnection to rear finger pivot 717 by way of tap 737, which isconfigured to adjustably receive a pin or a bolt type fastener (notshown). Rear finger arm 735 is also adjustably and reversibly coupled tocenter finger pivot member 719 by way of a threaded portion, which isrotatably received by threaded tap 739 in center finger pivot member719.

Center finger housing member 745 comprises center finger securingelement 747, which comprises tap 749. Center finger pivot member 719also comprises tap 749. Tap 749 is configured to adjustably receive apin or a bolt type fastener (not shown), which provides a pivotallyadjustable and reversibly fixed connection between center finger housingmember 745 and center finger pivot 719.

Center finger pivot member 719 couples to center finger housing member741, which is configured to reversibly couple to a proximal portion of afinger of a user of the system such as a middle phalanx segment and aproximal phalanx segment. Center finger housing member 745 comprisesrear finger support frame 741, which is configured to reversibly receiveand support the proximal portion of the user's finger while providingmotion to a joint in a proximity to the proximal portion of the user'sfinger, such as an interphalangeal joint, e.g., a proximalinterphalangeal joint and a metacarpophalangeal joint. Center fingersupport frame 741 can comprise an inflexible material, such as metal,wood, plastic, and carbon fiber as well as center finger support frame743, a strap or belt that reversibly couples the proximal portion of theuser's finger to center finger housing member 741 and, thereby, fingerpivot assembly 715. Center finger coupling element 743 can comprise afastening member, such as Velcro, buttons, and hook and loop typefastener members.

Finger pivot assembly 715 further comprises drive coupling element 721,which comprises bore 751. Center finger pivot also comprises bore 751.Bore 751 is configured to adjustably receive a pin or a bolt typefastener (not shown), which provides a pivotally adjustable andreversibly fixed connection between center finger pivot 719 drivecoupling element 721.

Drive coupling element 721 and drive arm 755 further comprise bore 753,which is configured to adjustably receive a pin or a bolt type fastener(not shown) that provides a pivotally adjustable and reversibly fixedconnection between drive coupling element 721 and a drive arm 755. Drivearm 755 is fixedly attached to pulley type drive unit 757 and therebyprovides motion to the finger pivot assembly.

In certain embodiments, the hand motion assembly is coupled to a user ofthe system such that the wrist is set back with an angle in a range offrom about 10 degrees to about 20 degrees, positioning that facilitatesnatural functional grip. In such embodiments, finger movement initiatedby the pulleys can have an arch in a range of from about 150 degrees toabout 190 degrees. Also in such embodiments, every other finger housingcan be offset in a range of from about 0.5 inches to about 1.0 inches,providing clearance for the fingers while performing the flexionmovement. In certain embodiments, the finger housing can comprise anadjustable split clamp for adjusting to the user's finger length.

As used herein, the term “finger” includes all digits of the human hand,including, e.g., a thumb digit and first, second, third, and fourthdigits, sometimes referred to as pointer finger, index finger, ringfinger, and pinkie fingers.

FIG. 8 illustrates an embodiment of a control box useful in certainembodiments of the present invention. Control box 801 compriseselectrical energy delivery unit 805, a vibratory energy delivery unit810 that comprises vibrator switch 812, six stepper motors 815 thatprovide motion to a joint motion assembly, drive member linking cables819 that operatively couple, through pulleys 814, a motion of steppermotor 815 to a joint motion assembly (not shown). Sensor 817 isconfigured to produce signals indicative of a temperature of the controlbox 801 and direction, speed, and position of stepper motor 815. Controlbox 801 comprises BS2 control board 820 that comprises a micro-processor(not shown), fan 825, and power supply 830. Power supply 830 isconfigured to provide power to electrical energy delivery unit 805,vibratory energy delivery unit 810, stepper motors 815, BS2 controlboard 820, and fan 825. Control box 801 further comprises 110alternating current socket 835, USB port 840, and fire wire port 845.

In certain embodiments, a control box microprocessor is in communicationwith sensor 817 of stepper motor 815, electrical energy delivery unit805, and vibratory energy delivery unit 810. In certain embodiments, acontrol box microprocessor can be programmed to coordinate a motionprovided to a joint of a user of the system, by a joint motion assembly,with the provision of electrical energy by the electrical energydelivery unit 805 to a neuron, a muscle, or combination thereof of theuser of the system. In certain embodiments, a control box microprocessorcan be programmed to coordinate a motion provided to a joint of the userof the system, by a joint motion assembly, with the provision ofvibratory energy by vibratory energy delivery unit 810 to a muscle,Golgi body or other mechanorecptor, tendon, or combination thereof ofthe user of the system. In certain embodiments, a control boxmicroprocessor can be programmed to save information about the user'suse of the system, e.g., speed of joint motion, range of joint motion,timing and amount of electrical and/or vibratory energy obtained fromsensor 817, stepper motors 815, electrical energy delivery unit 805,vibratory energy delivery unit 810, and/or a joint motion assembly whilea user uses the system.

In certain embodiments, a control box microprocessor is in communicationwith sensor 817 and fan 825. In certain embodiments, a control boxmicroprocessor can be programmed to activate fan 825 in response tosignals from the temperature sensor indicative of a thresholdtemperature in the control box.

In certain embodiments, chains (not shown) can be used instead of ortogether with drive member linking cables 819. In certain embodiments,sprockets (not shown) can be used instead of or together with pulleys814.

In certain embodiments, a joint motion system can comprise at least twoof an ankle joint motion assembly, a knee joint motion assembly, a hipjoint motion assembly, a shoulder joint motion assembly, an elbow jointmotion assembly, a wrist joint motion assembly, and a hand joint motionassembly.

In certain embodiments, a control box determines the inflection pointjoint angles of flexion and extension movements provided by a passivejoint motion assembly based upon a comparison of the magnitude of jointmotion assembly position sensor signals with predetermined values ofinflection point joint angles of flexion and extension. When eachpredetermined joint angle inflection point value is reached by the jointmotion assemble, the control unit changes the direction of a drive unitto change the direction of movement of the joint of a user moved by thejoint motion assembly.

In certain embodiments, a joint motion assembly is configured with voicerecognition capability so that the joint motion assembly provides apreprogrammed movement to a joint in response to a spoken command. Forinstance, a hand joint motion assembly, configured as a glove, can beconfigured to open or close a user's hand in response to spoken commandssuch as “open” and “close,” respectively. Along these lines, a glovestyle hand joint motion assembly can be configured to bring digits ofthe hand, e.g. the index and thumb, together in response to a spokencommand such as “pinch,” or to raise the index finger in response to aspoken command such as “point.” Voice recognition programs are known andcan be provided by, e.g., a control box comprising a microphone or othersound-detecting device coupled to microprocessor means having voicerecognition capabilities.

In certain embodiments, a joint motion assembly can comprise vibratoryelements positioned to provide vibratory stimulation to a muscle, anerve, a tendon, a Golgi body or other mechanoreceptor, or combinationsthereof that is in a proximity of a joint adjacent to a dysfunctionalmuscle of the user of the system being treated. In certain embodiments,vibratory elements can provide vibratory stimulation while a joint ofthe user is being moved by the joint motion assembly or while the jointis stationary. In certain embodiments, a vibratory element can providevibratory stimulation while the joint of the user is being moved by thejoint motion assembly in a repeated series of movements comprising acycle; and the vibratory stimulation can be provided continuouslythroughout the cycle or intermittently throughout the cycle. In certainembodiments, the vibratory stimulation can be provided near jointmovement inflection points. As used here, the term “near joint movementsinflection points” includes joint angles about 1°, about 2°, about 3°,about 4°, about 5°, about 6°, about 7°, about 8°, about 90°, about 10°,about 11°, about 12°, about 13°, about 14°, about 15°, about 16°, about17°, about 18°, about 19°, about 20°, about 21°, about 22°, about 23°,about 24°, about 25°, about 30°, about 35°, and about 40° in of aninflection point of a joint motion. In certain embodiments, thevibratory stimulation can be provided in an amount effective to resultin a depolarization of a neuron, a Golgi organ or other mechanoreceptor,or a combination thereof.

In certain embodiments, a joint motion assembly can comprise electricalelements positioned to provide electrical stimulation to a muscle, anerve, a tendon, a Golgi organ or other mechanoreceptor, or combinationthereof that is in a proximity of a joint adjacent to a dysfunctionalmuscle of a user of the system being treated. In certain embodiments,electrical elements can provide electrical stimulation while a joint ofthe user is being moved by the joint motion assembly or while the jointis stationary. In certain embodiments, the electrical elements canprovide electrical stimulation while the joint of the user is beingmoved by the joint motion assembly in a repeated series of movementscomprising a cycle; and the electrical stimulation can be provided nearjoint movement inflection points.

In certain embodiments, the electrical stimulation can be provided in anamount effective to result in a depolarization of a motor neuron, asensory neuron, a Golgi organ or other mechanoreceptor, a muscle, or acombination thereof. In certain embodiments, the depolarization of amuscle resulting from the electrical stimulation results in acontraction of the muscle. In certain embodiments, the contraction ofthe muscle assists a joint motion assembly providing motion to a jointof a user of the system (i.e., a contraction of the muscle is agonisticto the joint motion provided by the joint motion assembly). In certainembodiments, the contraction of the muscle opposes a joint motionassembly provides motion to a joint of a user of the system (i.e., acontraction of the muscle is antagonistic to the joint motion providedby the joint motion assembly). In certain embodiments, electricalmembers can comprise transdermal stimulating pads. In certainembodiments, a transdermal electrical pad that provides positiveelectrical energy can be positioned at an intrinsic muscle of the userthat is adjacent to a joint moved by the joint motion assembly andanother transdermal electrical pad that provides negative electricalstimulation energy can be positioned above a point of injury to the userthat has resulted in a muscle dysfunction in the user, such as on theback of the user's neck, such that, when the positive transdermalelectrical pad and the negative transdermal electrical pad provideelectrical energy to a user, a residual stimulation is forced throughthe nervous system in past the point of injury. In certain embodiments,the vibratory stimulation and the electrical stimulation can be providedin a coordinated manner or in a non-coordinated manner. For instance,vibratory and electrical stimulation can be provided simultaneously orin a series in which vibratory and/or electrical stimulation areprovided when a joint, moved by a joint motion assembly, achieves one ormore particular joint angles.

In certain embodiments, one or more vibration elements, such as coinstyle vibrators, can be configured and positioned to deliver stimulatoryvibration energy to at least one of a dysfunctional muscle and a tendonof a dysfunctional muscle. In certain embodiments, one or more vibrationelements, such as coin style vibrators, can be configured and positionedto deliver stimulatory vibration energy to at least one of a muscleadjacent to a dysfunctional muscle and a tendon adjacent to adysfunctional muscle. In some embodiments, a vibration element can bebuilt into a joint motion assembly.

In certain embodiments, stimulatory neuromuscular electrical energy canbe applied to a user of the muscle therapy system by at least twoelectrical leads positioned and configured for transcutaneous deliveryof the stimulatory electrical energy or positioned and configured forintramuscular delivery of the stimulatory electrical energy. Thestimulatory electrical energy can be delivered in an amount effective toresult in at least one of a contraction of a muscle, a depolarization ofat least a portion of a membrane of a muscle cell, and a depolarizationof at least portion of a membrane of a nerve cell. In some embodiments,a negative electrical lead can be placed adjacent to a joint moved by ajoint motion assembly and a positive electrical lead can be positionedat a site at the core of the body of user. In some embodiments, anegative electrical lead that can be positioned adjacent to and above asite of injury on an extremity of the body of the user and a positiveelectrical lead can be positioned at the distal end of the extremity.

In certain embodiments, magnets can be used in combination with a jointmotion assembly and at least one of stimulatory vibrational energy andstimulatory neuromuscular electrical energy.

In some embodiments, an inflection point joint angle of a dorsiflexionmovement provided to an ankle joint by a joint motion assembly is about10 degrees, about 7 degrees, about 5 degrees, or about 2 degrees. Insome embodiments, an inflection point joint angle of a dorsiflexionmovement provided to an ankle joint by a joint motion assembly is about30 degrees, about 25 degrees, about 20 degrees, about 15 degrees, about10 degrees, about 5 degrees, or about 2 degrees. In some embodiments, aninflection point joint angle of a dorsiflexion movement or aplantarflexion movement provided to an ankle joint by a joint motionassembly corresponds to an angle measured by a goniometer in which thefulcrum of the goniometer is aligned with the lateral malleolus of theuser, the stationary arm of the goniometer is in line with the midlineof the lower leg of the user, using the head of the fibula forreference, and the moving arm of the goniometer is parallel to the fifthmetatarsal of the user.

In some embodiments, an inflection point joint angle of an inversionmovement of a tarsal joint provided by a joint motion assembly is about45 degrees, about 40 degrees, about 35 degrees, about 30 degrees, about25 degrees, about 20 degrees, about 15 degrees, about 10 degrees, about5 degrees, or about 2 degrees. In some embodiments, an inflection pointjoint angle of an eversion movement of a tarsal joint by a joint motionassembly is about 25 degrees, about 20 degrees, about 15 degrees, about10 degrees, about 5 degrees, or about 2 degrees. In some embodiments, aninflection point joint angle of an inversion movement or an eversionmovement of a tarsal joint provided by a joint motion assemblycorresponds to an angle measured by a goniometer in which the fulcrum ofthe goniometer is positioned between the two malleoli of the user, thestationary arm of the goniometer is in line with the midline of thetibia of the user, and the moving arm of the goniometer is in line withthe second metatarsal of the user.

In some embodiments, an inflection point joint angle of an inversionmovement of a subtalar joint provided by a joint motion assembly is 20degrees, about 15 degrees, about 10 degrees, about 5 degrees, or about 2degrees. In some embodiments, an inflection point joint angle of aneversion movement of a subtalar joint by a joint motion assembly isabout 15 degrees, about 10 degrees, about 5 degrees, or about 2 degrees.In some embodiments, an inflection point joint angle of an inversionmovement or an eversion movement of a subtarsal joint provided by ajoint motion assembly corresponds to an angle measured by a goniometerin which the fulcrum of the goniometer is positioned between the twomalleoli of the user, the stationary arm of the goniometer is in linewith the midline of the leg of the user, and the moving arm of thegoniometer is in line with the midline of the calcaneus of the user.

In some embodiments, an inflection point joint angle of a flexionmovement provided to a knee joint by a joint motion assembly is about150 degrees, about 140 degrees, about 130 degrees, about 120 degrees,about 110 degrees, about 100 degrees, about 90 degrees, about 80degrees, about 70 degrees, about 60 degrees, about 50 degrees, about 40degrees, about 30 degrees, about 20 degrees, about 10 degrees, or about5 degrees. In some embodiments, an inflection point joint angle of anextension movement provided to a knee joint by a joint motion assemblyis about negative 10 degrees, about negative 5 degrees, about 0 degrees,about 5 degrees, about 10 degrees, about 20 degrees, about 30 degrees,about 40 degrees, and about 50 degrees. In some embodiments, aninflection point joint angle of a flexion movement or an extensionmovement provided to an ankle joint by a joint motion assemblycorresponds to an angle measured by a goniometer in which the fulcrum ofthe goniometer is aligned with the lateral epicondyle of the femur ofthe user, the stationary arm of the goniometer is in line in line withthe greater trochanter and midline of the femur of the user, and themoving arm of the goniometer is in line with the lateral malleolus andmidline of the fibula of the user.

In some embodiments, an inflection point joint angle of a flexionmovement provided to a hip joint by a joint motion assembly is about 130degrees, about 120 degrees, about 110 degrees, about 100 degrees, about90 degrees, about 80 degrees, about 70 degrees, about 60 degrees, about50 degrees, about 40 degrees, about 30 degrees, about 20 degrees, about10 degrees, or about 5 degrees. In some embodiments, an inflection pointjoint angle of an extension movement provided to a hip joint by a jointmotion assembly is about 30 degrees, about 20 degrees, about 10 degrees,or about 5 degrees. In some embodiments, an inflection point joint angleof a flexion movement or an extension movement provided to a knee jointby a joint motion assembly corresponds to an angle measured by agoniometer in which the fulcrum of the goniometer is aligned with thegreater trochanter of the femur of the user, the stationary arm of thegoniometer is positioned along the lateral midline of the abdomen, usingthe pelvis for reference, of the user, and the moving arm of thegoniometer is in line with the lateral midline of the femur of the user.

In some embodiments, an inflection point joint angle of an abductionmovement provided to a hip joint by a joint motion assembly is about 50degrees, about 40 degrees, about 30 degrees, about 20 degrees, about 10degrees, or about 5 degrees. In some embodiments, an inflection pointjoint angle of an adduction movement provided to a hip joint by a jointmotion assembly is about 30 degrees, about 20 degrees, about 10 degrees,or about 5 degrees. In some embodiments, an inflection point joint angleof an abduction movement or an adduction movement provided to a hipjoint by a joint motion assembly corresponds to an angle measured by agoniometer in which the fulcrum of the goniometer is in line with theanterior superior iliac spine of the user, the stationary arm of thegoniometer is in line with the opposite anterior superior iliac spine ofthe user, and the moving arm of the goniometer is aligned with themidline of the patella of the user.

In some embodiments, an inflection point joint angle of a medialrotation movement provided to a hip joint by a joint motion assembly isabout 50 degrees, about 40 degrees, about 30 degrees, about 20 degrees,about 10 degrees, or about 5 degrees. In some embodiments, an inflectionpoint joint angle of lateral rotation movement provided to a hip jointby a joint motion assembly is about 40 degrees, about 30 degrees, about20 degrees, about 10 degrees, or about 5 degrees. In some embodiments,an inflection point joint angle of a medial rotation movement or lateralrotation movement provided to a hip joint by a joint motion assemblycorresponds to an angle measured by a goniometer in which the fulcrum ofthe goniometer is aligned with the patella of the user, the stationaryarm of the goniometer is in line with the midline of the tibia of theuser, and the moving arm of the goniometer is also in line with themidline of the tibia of the user.

In some embodiments, an inflection point joint angle of a flexionmovement provided to a shoulder joint by a joint motion assembly isabout 180 degrees, about 170 degrees, about 160 degrees, about 150degrees, about 140 degrees, about 130 degrees, about 120 degrees, about110 degrees, about 100 degrees, about 90 degrees, about 80 degrees,about 70 degrees, about 60 degrees, about 50 degrees, about 40 degrees,about 30 degrees, about 20 degrees, about 10 degrees, or about 5degrees. In some embodiments, an inflection point joint angle of anextension movement provided to a shoulder joint by a joint motionassembly is about 60 degrees, about 50 degrees, about 40 degrees, about30 degrees, about 20 degrees, about 10 degrees, or about 5 degrees. Insome embodiments, an inflection point joint angle of a flexion movementor an extension movement provided to a shoulder joint by a joint motionassembly corresponds to an angle measured by a goniometer in which thefulcrum of the goniometer is placed over the acromion process of theuser, the stationary arm of the goniometer is positioned in line withthe midline of the humerus of the user, and the moving arm of thegoniometer is in line with the lateral epicondyle of the user.

In some embodiments, an inflection point joint angle of an abductionmovement provided to a shoulder joint by a joint motion assembly isabout 180 degrees, about 170 degrees, about 160 degrees, about 150degrees, about 140 degrees, about 130 degrees, about 120 degrees, about110 degrees, about 100 degrees, about 90 degrees, about 80 degrees,about 70 degrees, about 60 degrees, about 50 degrees, about 40 degrees,about 30 degrees, about 20 degrees, about 10 degrees, or about 5degrees. In some embodiments, an inflection point joint angle of anabduction movement provided to a shoulder joint by a joint motionassembly corresponds to an angle measured by a goniometer in which thefulcrum of the goniometer is placed at the acromion process of the user,the stationary arm of the goniometer is aligned with the anteriormidline of the humerus of the user, and the moving arm of the goniometeris also aligned with the anterior midline of the humerus of the user.

In some embodiments, an inflection point joint angle of a medialrotation movement provided to a shoulder joint by a joint motionassembly is about 70 degrees, about 60 degrees, about 50 degrees, about40 degrees, about 30 degrees, about 20 degrees, about 10 degrees, orabout 5 degrees. In some embodiments, an inflection point joint angle oflateral rotation movement provided to a shoulder joint by a joint motionassembly is about 40 degrees, about 30 degrees, about 20 degrees, about10 degrees, or about 5 degrees. In some embodiments, an inflection pointjoint angle of a medial rotation movement or a lateral rotation movementprovided to a shoulder joint by a joint motion assembly corresponds toan angle measured by a goniometer in which the user is supine with 90degrees of shoulder abduction and 90 degrees of elbow flexion and inwhich the fulcrum of the goniometer is centered over the olecranonprocess of the user, the stationary arm of the goniometer is alignedwith the ulnar styloid the user, and the moving arm of the goniometer isperpendicular to the floor.

In some embodiments, an inflection point joint angle of a flexionmovement provided to an elbow joint by a joint motion assembly is about160 degrees, about 150 degrees, about 140 degrees, about 130 degrees,about 120 degrees, about 110 degrees, about 100 degrees, about 90degrees, about 80 degrees, about 70 degrees, about 60 degrees, about 50degrees, about 40 degrees, about 30 degrees, about 20 degrees, about 10degrees, or about 5 degrees. In some embodiments, an inflection pointjoint angle of a flexion movement provided to an elbow joint by a jointmotion assembly corresponds to an angle measured by a goniometer inwhich the fulcrum of the goniometer is aligned with the lateralepicondyle of the humerus of the user, the stationary arm of thegoniometer is positioned along the midline of the humerus of the user,and the moving arm of the goniometer is aligned with the radial styloidprocess of the user.

In some embodiments, an inflection point joint angle of a supinationmovement provided to an elbow joint by a joint motion assembly is about100 degrees, about 90 degrees, about 80 degrees, about 70 degrees, about60 degrees, about 50 degrees, about 40 degrees, about 30 degrees, about20 degrees, about 10 degrees, or about 5 degrees. In some embodiments,an inflection point joint angle of pronation movement provided to anelbow joint by a joint motion assembly is about 90 degrees, about 80degrees, about 70 degrees, about 60 degrees, about 50 degrees, about 40degrees, about 30 degrees, about 20 degrees, about 10 degrees, or about5 degrees. In some embodiments, an inflection point joint angle of asupination rotation movement or a pronation rotation movement providedto an elbow joint by a joint motion assembly corresponds to an anglemeasured by a goniometer in which the fulcrum of the goniometer isplaced just behind the ulnar styloid process of the user, the stationaryarm of the goniometer is parallel with the anterior midline of thehumerus of the user, and the moving arm of the goniometer parallel withthe anterior midline of the humerus of the user.

In certain embodiments, an inflection point joint angle for any jointmovement described herein can be calculated visually. Additionalgoniometer methods are known in the art, such as those described byGreene M D, Walter B, and James D. Heckman M D. The Clinical Measurementof Joint Motion. Rosemont: American Academy of Orthopaedic Surgeons,1994 and Hislop, Helen, and Jacqueline Montgomery. Daniels andWorthingham's Muscle Testing: Techniques of Manual Examination. 6^(th)ed. Philadelphia: W B Saunders, 1995, the contents of each of which arehereby incorporated by reference in their entireties.

In some embodiments, an inflection point joint angle of a flexionmovement of a finger metacarpophalangeal (MCP) joint provided by a jointmotion assembly is about 90 degrees, about 80 degrees, about 70 degrees,about 60 degrees, about 50 degrees, about 40 degrees, about 30 degrees,about 20 degrees, about 10 degrees, or about 5 degrees. In someembodiments, an inflection point joint angle of an extension movementprovided to a finger MCP joint by a joint motion assembly is aboutnegative 20 degrees, about negative 10 degrees, about negative 5degrees, about 0 degrees, about 5 degrees, about 10 degrees, about 20degrees, about 30 degrees, about 40 degrees, and about 50 degrees.

In some embodiments, an inflection point joint angle of a flexionmovement of a finger proximal interphalangeal (PIP) joint provided by ajoint motion assembly is about 120 degrees, about 110 degrees, about 100degrees, about 90 degrees, about 80 degrees, about 70 degrees, about 60degrees, about 50 degrees, about 40 degrees, about 30 degrees, about 20degrees, about 10 degrees, or about 5 degrees. In some embodiments, aninflection point joint angle of an extension movement provided to afinger PIP joint by a joint motion assembly is about negative 10degrees, about negative 5 degrees, about 0 degrees, about 5 degrees,about 10 degrees, about 20 degrees, about 30 degrees, about 40 degrees,and about 50 degrees.

In some embodiments, an inflection point joint angle of a flexionmovement of a finger distal interphalangeal (DIP) joint provided by ajoint motion assembly is about 90 degrees, about 80 degrees, about 70degrees, about 60 degrees, about 50 degrees, about 40 degrees, about 30degrees, about 20 degrees, about 10 degrees, or about 5 degrees. In someembodiments, an inflection point joint angle of an extension movementprovided to a finger DIP joint by a joint motion assembly is aboutnegative 10 degrees, about negative 5 degrees, about 0 degrees, about 5degrees, about 10 degrees, about 20 degrees, about 30 degrees, about 40degrees, and about 50 degrees.

In some embodiments, an inflection point joint angle of a flexionmovement of a thumb MCP joint is about 70 degrees, about 60 degrees,about 50 degrees, about 40 degrees, about 30 degrees, about 20 degrees,about 10 degrees, or about 5 degrees. In some embodiments, an inflectionpoint joint angle of an extension movement provided to a thumb MCP jointby a joint motion assembly is about negative 10 degrees, about negative5 degrees, about 0 degrees, about 5 degrees, about 10 degrees, about 20degrees, about 30 degrees, about 40 degrees, and about 50 degrees.

In some embodiments, an inflection point joint angle of a flexionmovement of a thumb interphalangeal joint is about 60 degrees, about 50degrees, about 40 degrees, about 30 degrees, about 20 degrees, about 10degrees, or about 5 degrees. In some embodiments, an inflection pointjoint angle of an extension movement provided to a thumb interphalangealjoint by a joint motion assembly is about negative 10 degrees, aboutnegative 5 degrees, about 0 degrees, about 5 degrees, about 10 degrees,about 20 degrees, about 30 degrees, about 40 degrees, and about 50degrees.

In certain embodiments, the user of the system suffers from diminishedmuscle function due to nerve damage resulting from, for example, aneurological defect causing paralysis, paresis, or dyscoordination. Incertain embodiments, a dysfunctional muscle undergoing therapy may havediminished capacity due to nerve damage resulting from, for instance, apartially or completely severed nerve, a tumor compression or othercompression of a nerve, a stroke, a transient ischemic attack, aneurodegenerative disease, e.g., ALS-Lou Gehrig's disease, Huntington'sdisease, multiple sclerosis, and Alzheimer's disease.

In certain embodiments, joint movement produced by an agonist muscularcontraction and/or by a joint motion assembly on one side of a jointstretches antagonist muscles on the other side of the joint, which canresult in motor neuron activation, muscle spindle activation, Golgitendon organ or other mechanoreceptor activation, or combinationsthereof in agonist and/or antagonist muscles and tendons thereof. Incertain embodiments, stimulatory vibration of, e.g., a motor neuron, amuscle, a tendon, or a combination thereof, at frequencies of, e.g.,about 30 pulses per second (pps), 40 pps, 50 pps, 60 pps, 70 pps, 80pps, 90 pps, 100 pps, 150 pps, 200 pps, 250 pps, 500 pps, 750 pps, and1000 pps can result in motor neuron activation, muscle spindleactivation, Golgi tendon organ or other mechanoreceptor activation, orcombinations thereof. Such stimulatory vibration can result in aperception of the user that a joint moved by a muscle contraction, ajoint motion assembly, or a combination thereof, moves a greater amountthan it actually does. In certain embodiments, stimulatory vibration ofa muscle spindle, Golgi tendon organ or other mechanoreceptor, orcombinations thereof, at lower frequencies of, e.g., about 25 pps, 20pps, 15 pps, 10 pps, 5 pps, and 2 pps can result in muscle spindleactivation, Golgi tendon organ or other mechanoreceptor activation, orcombinations thereof. Such stimulatory vibration can result in aperception of the user that the joint moves a lesser amount than itactually does.

In certain embodiments, stimulatory vibration can be used in combinationwith a joint motion assembly, electrical neuromuscular stimulation, orboth. In embodiments where stimulatory vibration is used in combinationwith a joint motion assembly, the stimulatory vibration can be appliedthroughout the cycle of movement provided to a joint by the joint motionassembly. The stimulatory vibration can also be applied non-continuouslyin cycles of movement provided to a joint of the joint motion assembly.For instance, the stimulatory vibration can be initially applied whenthe joint motion assembly has moved the joint a certain percentage ofthe range of motion the joint motion assembly moves the joint: the rangeof motion being defined by opposing joint movement inflection points andexemplary percentages of the range of motion at which stimulatoryvibration is initially applied include about 10%, about 15%, about 20%,about 25%, about 30%, about 35%, about 40%, about 45%, about 50%, about55%, about 60%, about 65%, about 70%, about 75%, about 80%, about 85%,about 90%, and about 95%.

The period of time for which stimulatory vibration is applied can vary,and the period can be defined by time or by a percentage of the range ofmotion that the joint motion assembly moves the joint. Exemplary timeperiods for which stimulatory vibration can be applied include about 1ms, about 10 ms, about 100 ms, about 250 ms, about 500 ms, about 750 ms,about 1 second, about 1.25 seconds, about 1.5 seconds, about 1.75seconds, about 2 seconds, about 3 seconds, about 5 seconds, about 10seconds, about 15 seconds, about 20 seconds, about 25 seconds, about 30seconds, about 35 seconds, about 40 seconds, about 45 seconds, about 50seconds, about 50 seconds, about 55 seconds, about 1 minute, about 1.25minutes, about 1.5 minutes, about 1.75 minutes, about 2 minutes, about 3minutes, about 4 minutes, about 5 minutes, and 10 minutes. Exemplarypercent ranges of motion for which stimulatory vibration can be appliedinclude about 1%, about 2%, about 3%, about 4%, about 5%, about 10%,about 15%, about 20%, about 25%, about 30%, about 35%, about 40%, about45%, about 50%, about 55%, about 60%, about 65%, about 70%, about 75%,about 80%, about 85%, about 90%, and about 95%. In embodiments wherestimulatory vibration is applied non-continuously in combination with ajoint motion assembly providing movement to a joint, a singlestimulatory vibration period or a plurality of stimulatory vibrationperiods can be used in the cycle of movement provided to the joint bythe joint motion assembly. In certain embodiments, stimulatory vibrationcan be applied when a joint is at a point, in a cycle of movementprovided by joint motion assembly, at which the joint is not a motion,e.g., a joint movement inflection point in the cycle or a stop point inthe cycle.

In certain embodiments, electrical neuromuscular stimulation can be usedin combination with a joint motion assembly, stimulatory vibration, orboth. In embodiments where electrical neuromuscular stimulation is usedin combination with a joint motion assembly, the stimulatory electricalenergy can be applied throughout the cycle of movement provided to ajoint by the joint motion assembly. The stimulatory electrical energycan also be applied non-continuously in cycles of movement provided to ajoint of the joint motion assembly. For instance, the stimulatoryelectrical energy can be initially applied when the joint motionassembly has moved the joint a certain percentage of the range of motionthe joint motion assembly moves the joint: the range of motion beingdefined by opposing joint movement inflection points and exemplarypercentages of the range of motion at which stimulatory vibration isinitially applied include about 10%, about 15%, about 20%, about 25%,about 30%, about 35%, about 40%, about 45%, about 50%, about 55%, about60%, about 65%, about 70%, about 75%, about 80%, about 85%, about 90%,and about 95%. The period of time for which stimulatory electricalenergy is applied can vary, and the period can be defined by time or bya percentage of the range of motion that the joint motion assembly movesthe joint. Exemplary time periods for which stimulatory electricalenergy can be applied include about 1 millisecond (ms), about 10 ms,about 100 ms, about 250 ms, about 500 ms, about 750 ms, about 1 second,about 1.25 seconds, about 1.5 seconds, about 1.75 seconds, about 2seconds, about 3 seconds, about 5 seconds, about 10 seconds, about 15seconds, about 20 seconds, about 25 seconds, about 30 seconds, about 35seconds, about 40 seconds, about 45 seconds, about 50 seconds, about 50seconds, about 55 seconds, and about 1 minute. Exemplary percent rangesof motion for which stimulatory electrical energy can be applied includeabout 1%, about 2%, about 3%, about 4%, about 5%, about 10%, about 15%,about 20%, about 25%, about 30%, about 35%, about 40%, about 45%, about50%, about 55%, about 60%, about 65%, about 70%, about 75%, about 80%,about 85%, about 90%, and about 95%. In embodiments where stimulatoryelectrical energy is applied non-continuously in combination with ajoint motion assembly providing movement to a joint, a singlestimulatory vibration period or a plurality of stimulatory vibrationperiods can be used in the cycle of movement provided to the joint bythe joint motion assembly. In certain embodiments, stimulatoryelectrical energy can be applied when a joint is at a point, in a cycleof movement provided by joint motion assembly, at which the joint is nota motion, e.g., a joint movement inflection point in the cycle or a stoppoint in the cycle.

In certain embodiments, stimulatory vibration and stimulatory electricalenergy can both be applied in the course of a cycle of movement providedto a joint by a joint motion assembly. In embodiments where stimulatoryvibration and stimulatory electrical energy are applied in the course ofa cycle of movement provided by a joint motion assembly, the points andperiods in which the stimulatory vibration in the stimulatory electricalenergy are applied can be the same or different and can be discrete oroverlapping.

What is claimed is:
 1. An apparatus, for treating diminished musclefunction in an upper extremity, comprising: an electrical member thatdelivers electrical energy to a hand region comprising at least one of adigit, a hand, and a wrist, the hand region comprising a dysfunctionalmuscle; a hand joint motion assembly that couples to the hand region andprovides, by an electric motor, a joint motion, in a cycle comprisingopposing joint movements, to a joint, at a junction of two bones formingan angle for which the junction is the vertex, to which thedysfunctional muscle ordinarily provides motion; and that controls (i) atiming of electrical energy delivery by the member and (ii) an amount ofelectrical energy delivered by the member; wherein the angle is at aminimum at maximal flexion of the joint and is at a maximum at maximalextension of the joint; wherein the timing of electrical energy deliveryis controlled to occur only while both of the following occursimultaneously: (i) the angle is within about 30 degrees of at least oneof the minimum and maximum, and (ii) motion is being provided to thejoint by the joint motion assembly; and wherein the amount of electricalenergy delivered is effective to result in a depolarization of at leastone of the dysfunctional muscle and a nerve that innervates thedysfunctional muscle.
 2. The system of claim 1, wherein thedepolarization results in a contraction of the dysfunctional muscle. 3.The system of claim 2, wherein the contraction results in a force on thejoint that is antagonistic toward the joint movement being provided bythe joint motion assembly at the time of contraction.
 4. The system ofclaim 2, wherein the contraction results in a force on the joint that isprotagonistic toward the joint motion being provided by the joint motionassembly at the time of contraction.
 5. The system of claim 1, whereinthe member delivers the electrical energy when the angle is within about20 degrees of the at least one of the minimum and maximum.
 6. The systemof claim 1, wherein the member delivers the electrical energy when theangle is within about 15 degrees of the at least one of the minimum andmaximum.
 7. The system of claim 1, wherein the member delivers theelectrical energy when the angle is within about 10 degrees of the atleast one of the minimum and maximum.
 8. The system of claim 1, whereinthe member delivers the electrical energy when the angle is within about5 degrees of the at least one of the minimum and maximum.
 9. The systemof claim 1, further comprising a vibratory member, in communication withthe assembly, that delivers vibratory energy to at least one of thedigit, the hand, and the wrist effective to result in activation of amechanoreceptor in proximity to the joint.
 10. A method, for treatingdiminished muscle function in an upper extremity, comprising: contactingan electrical member, configured to deliver electrical energy, to a handregion comprising at least one of a digit, a hand, and a wrist, the handregion comprising a dysfunctional muscle; with an electric motor of ajoint motion assembly, providing a joint motion, in a cycle comprisingopposing joint movements, to a joint of the hand region, at a junctionof two bones forming angle for which the junction is the vertex, towhich the dysfunctional muscle ordinarily provides movement; wherein theangle is at a minimum at maximal flexion of the joint and is at amaximum at maximal extension of the joint; and with the electricalmember, delivering an amount of electrical energy to the hand regiononly while both of the following occur simultaneously: (i) the angle ispositioned within about 30 degrees of at least one of the minimum andmaximum, and (ii) the joint motion is being provided to the joint;wherein the amount of electrical energy delivered is effective to resultin a depolarization, in the hand region, of at least one of thedysfunctional muscle and a nerve that innervates the dysfunctionalmuscle.
 11. The method of claim 10, wherein the depolarization resultsin a contraction the dysfunctional muscle.
 12. The method of claim 11,wherein the contraction results in a force on the joint that isantagonistic toward the joint movement being provided by the jointmotion assembly at the time of contraction.
 13. The method of claim 11,wherein the contraction results in a force on the joint that isprotagonistic toward the joint movement being provided by the jointmotion assembly at the time of contraction.
 14. The method of claim 10,wherein the delivery of electrical energy occurs when the an is withinabout 20 degrees of the at least one of the minimum and maximum.
 15. Themethod of claim 10, wherein the delivery of electrical energy occurswhen the angle is within 15 degrees of the at least one of the minimumand maximum.
 16. The method of claim 10, wherein the delivery ofelectrical energy occurs when the angle is within 10 degrees of the atleast one of the minimum and maximum.
 17. The method of claim 10,wherein the delivery of electrical energy occurs when the an is within 5degrees of the at least one of the minimum and maximum.